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2 New global threats emerge: SARS-like disease and new lethal bird flu

May 13, 2013 at 7:57 pm By Roz Potter

From  a Yahoo News story today and one published  last month in the Economist, we are reminded that the threat of another SARS -like global outbreak or flu pandemic remains ever-present.

Here is the Economist’s take on these new threats:

The threat of a global pandemic is rising again. In China an influenza virus never before seen in people had, as The Economist went to press, infected at least 82 and killed 17. Meanwhile a new type of coronavirus, the family that brought severe acute respiratory syndrome (SARS), is festering in the Middle East. The risk of such an outbreak turning into a pandemic is low, but the danger, if it does, is huge: in 1918 50m-100m people were killed by Spanish flu, compared with 16m in the first world war and 30m so far from AIDS.

More

Next, today’s story on Yahoo News

LONDON (AP) — Two respiratory viruses in different parts of the world have captured the attention of global health officials — a novel coronavirus in the Middle East and a new bird flu spreading in China.

Last week, the coronavirus related to SARS spread to France, where one patient who probably caught the disease in Dubai infected his hospital roommate. Officials are now trying to track down everyone who went on a tour group holiday to Dubai with the first patient as well as all contacts of the second patient. Since it was first spotted last year, the new coronavirus has infected 34 people, killing 18 of them. Nearly all had some connection to the Middle East.

The World Health Organization, however, says there is no reason to think the virus is restricted to the Middle East and has advised health officials worldwide to closely monitor any unusual respiratory cases.

At the same time, a new bird flu strain, H7N9, has been infecting people in China since at least March, causing 32 deaths out of 131 known cases.

WHO, which is closely monitoring the viruses, says both have the potential to cause a pandemic — a global epidemic — if they evolve into a form easily spread between people. Here’s a crash course in what we know so far about them:

More

Dangerous treatment-resistant TB spreading rapidly in Europe (and elsewhere)

September 13, 2011 at 11:23 pm By Roz Potter

From the Globe and Mail:  Link

Tuberculosis is an airborne disease that knows no boundaries. It is spread person to person through air that is exhaled, coughed or sneezed by infected individuals. Exposed individuals who are very young, old, chronically ill or immunocompromised are at highest risk.

Excerpts:

“TB is an old disease that never went away, and now it is evolving with a vengeance,” said Zsuzsanna Jakab, the WHO’s Regional Director for Europe.

“The numbers are scary,” Lucica Ditiu, executive secretary of the Stop TB Partnership told a news conference in London. “This is a very dramatic situation.”

TB is currently a worldwide pandemic that kills around 1.7 million people a year. The infection is caused by the bacterium Mycobacterium tuberculosis and destroys patients’ lung tissue, causing them to cough up the bacteria, which then spreads through the air and can be inhaled by others.

Cases of multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) – where the infections are resistant to first-line and then second-line antibiotic treatments – are spreading fast, with about 440,000 new patients every year around the world.

Experts say around 7 per cent of patients with straightforward TB die, and that death rate rises to around 50 per cent of patients with drug-resistant forms.

According to the WHO and Stop TB, 15 of the 27 countries with the highest burden of MDR-TB are in the WHO’s European region, which includes 53 countries in Europe and Central Asia.

More than 80,000 MDR-TB cases occur in the region each year – almost a fifth of the world’s total. The WHO said precise figures for XDR-TB are not available because most countries lack the facilities to diagnose it, but officially reported cases of XDR-TB increased six-fold between 2008 and 2009.

Rates are highest in eastern Europe and Central Asia, but many countries in western Europe have increasing rates of TB and drug-resistant TB, Ditiu said. Britain’s capital, London, has the highest TB rate of any capital city in western Europe with around 3,500 cases a year, 2 per cent of which are MDR-TB.

Treating even normal TB is a long and unpleasant process, with patients needing to take a combination of powerful antibiotics for 6 months. Many patients fail to correctly complete the course of medicines, a factor which has fuelled a rise in drug-resistant forms of the disease.

Treatment regimes for MDR-TB and XDR-TB can stretch into two or more years, costing up to $16,000 in drugs alone and up to $200,000 to $300,000 per patient if isolation hospital costs, medical care and other resources are taken into account.

Dengue Fever: CDC advisory for travelers – it’s worse than you think

July 20, 2011 at 11:58 am By Roz Potter

From the CDC, (Centers for Disease Control and Prevention),  Link

Map of Dengue Fever distribution in the western hemisphere

Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas

This is an official CDC HEALTH ADVISORY

Summary

Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF).

The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas–both domestic and abroad–who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.

Background

Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean.

This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific.

With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler. The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.

Symptoms

Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF.

DF is a self-limited febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel.

Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence.

A small proportion of patients develop DHF, which is characterized by presence of resolving fever or a recent history of fever, lasting 2–7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count ≤100,000/mm3), and increased vascular permeability, evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock.

Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids. There is no antiviral drug or vaccine against the dengue virus. Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

  • Health care providers seeing patients with dengue-like illness who have recently traveled to Puerto Rico, Key West, Florida or international dengue-affected areas (See world distribution of dengue maps at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx) should report cases to the local or state health department and send specimens for laboratory testing.
  • DF and DHF are now nationally notifiable conditions in the United States. Please remember that apart from individuals traveling for tourism, individuals responding to international disasters (e.g., Haiti earthquake), participating in medical or religious missionary work, and visiting friends and relatives are often returning from dengue-affected areas and should be evaluated for dengue infection if they present with dengue-like illness during or after their travel.
  • Reporting to local public health officials and consideration of hospitalization to initiate supportive care should not be delayed pending test results. Reporting suspected dengue cases will trigger a public health investigation and the implementation of prevention measures.
  • Specimens from patients with acute febrile illness, who returned from dengue-affected areas within the past 14 days, should be submitted to their local or state health department, if the health department laboratory offers dengue testing. State health departments with the capacity to test for dengue include: AZ, CA, CT, FL, NY, PR, and TX.
  • If the local or state health department does not perform dengue testing, submit specimens directly to CDC laboratories in San Juan, Puerto Rico (address below). CDC offers free diagnostic testing for health care providers and confirmatory dengue testing for health department and private laboratories. A completed CDC Dengue Case Investigation Form (http://www.cdc.gov/Dengue/resources/DCIF_English_ColorSept1508_FINAL_.pdf) must accompany the specimens for the appropriate testing to be performed.

Whenever possible, submit paired acute and convalescent specimens (2 ml of centrifuged serum.) Accuracy is increased when both acute and convalescent specimens are available for testing. But providers should not wait and should submit acute specimens as soon as available; a convalescent specimen can be submitted when available.

Type of sample Interval since onset of symptoms Type of Analysis
Acute until day 5 RT-PCR for dengue virus
Convalescent 6 to 30 days ELISA for dengue IgM

Centers for Disease Control and Prevention
Dengue Branch
1324 Cañada Street
San Juan, Puerto Rico 00920
Tel: (787) 706-2399; fax (787) 706-2496

For More Information:

  • Call CDC’s toll-free information line, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day.

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

DEPARTMENT OF HEALTH AND HUMAN SERVICES


NYT: When food kills – antibiotic overuse in animals and the emerging antibiotic resistant organisms that kill humans

June 12, 2011 at 11:13 am By Roz Potter

From the NYT:  Link

Excerpts:

The deaths of 31 people in Europe from a little-known strain of E. coli have raised alarms worldwide, but we shouldn’t be surprised. Our food often betrays us. (editor’s note: in Europe, more than 3283 people have confirmed cases and at least 100 of these need kidney transplants, due to severe damage to their kidneys from the Shiga toxin-producing bacteria. Many more who have been sickened are not in the official count, for a variety of reasons).

Just a few days ago, a 2-year-old girl in Dryden, Va., died in a hospital after suffering bloody diarrhea linked to another strain of E. coli. Her brother was also hospitalized but survived.

Every year in the United States, 325,000 people are hospitalized because of food-borne illnesses and 5,000 die, according to the Centers for Disease Control and Prevention. That’s right: food kills one person every two hours.

Yet while the terrorist attacks of 2001 led us to transform the way we approach national security, the deaths of almost twice as many people annually have still not generated basic food-safety initiatives. We have an industrial farming system that is a marvel for producing cheap food, but its lobbyists block initiatives to make food safer.

Perhaps the most disgraceful aspect of our agricultural system — I say this as an Oregon farmboy who once raised sheep, cattle and hogs — is the way antibiotics are recklessly stuffed into healthy animals to make them grow faster.

The Food and Drug Administration reported recently that 80 percent of antibiotics in the United States go to livestock, not humans. And 90 percent of the livestock antibiotics are administered in their food or water, typically to healthy animals to keep them from getting sick when they are confined in squalid and crowded conditions.

The single state of North Carolina uses more antibiotics for livestock than the entire United States uses for humans.

This cavalier use of low-level antibiotics creates a perfect breeding ground for antibiotic-resistant pathogens. The upshot is that ailments can become pretty much untreatable.

Is U.S. vulnerable to E. coli outbreak like Europe’s?

June 9, 2011 at 9:36 am By Roz Potter

From the NPR health blog, Shots:  Link

Excerpts:

Dr. Christopher Braden, the chief of food- and waterborne diseases at the Centers for Disease Control and Prevention, doesn’t expect the Escherichia coli bug causing serious illness in northern Europe to leapfrog the Atlantic anytime soon.

Still, Braden tells Shots, “I am concerned about something similar that could happen in the United States.”

That’s because the U.S. already sees “quite a few infections every year” from Shiga-toxin-producing E. coli. That’s the dangerous kind that can destroy blood cells, clog arteries, cause intestinal bleeding and lead to kidney failure and death.

***

Officials estimate that at least 100,000 Americans suffer E. coli infections from toxin-producing organisms every year, sending thousands to the hospital and killing about 80 people. That’s a much bigger toll than the current German-centered outbreak — more than 2,400 cases, including more than 600 cases of kidney failure, and 23 deaths. But most cases occur one-by-one, not in big outbreaks.

There’s controversy over why the European bug is so bad.

Some experts think it’s not really more dangerous than earlier strains. It’s just that more people got exposed to it, or perhaps there was an unusually high level of contamination on whatever foods affected people ate.

Another hypothesis: Perhaps some of the most seriously ill cases were treated with antibiotics. Paradoxically, some think that can make matters worse. Some say that’s because more toxin is released from the E. coli that are killed off. Others think, in the case of a highly antibiotic-resistant bug like O104:H4, antibiotics kill off other intestinal flora but not the E. coli, leaving them a clear field.

University of Wisconsin infectious disease specialist Dr. Dennis Maki dismisses these theories. He has treated lots of people with bad E. coli infections over the years, and he says this one is clearly different.

Earlier strains were far less likely to put victims in the hospital with severe anemia and kidney failure, Braden says, with “rarely over 10 percent” of patients affected.

By contrast, Maki notes the European strain is hospitalizing about a third of its victims. “That’s extraordinary,” he tells Shots. “This is an extraordinarily virulent strain of E. coli. I think that’s becoming clear.”

Maki predicts that “we will see U.S. cases” of the European bug as it gets carried back to North America by travelers. “We could have a big outbreak with this strain in a year or two or three,” he says. “It’s not out of the question at all.”

Osterholm agrees that the bug will get around. “Are there going to be more outbreaks like we see in Germany right now occurring around the world?” he says. “I bet you there will be.”

That’s why experts want to learn everything they can about the European bug – how it got there, why it’s so deadly, and above all, how it gets into food.

***

“For a number of years, almost all of the strains of this kind of E. coli were that O157:H7,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Over the past 15 years, we’ve seen a very sizable increase in the number of non-O157:H7 strains.”

That’s thought to be due in large part to improvements food safety aimed at detecting and eliminating O157 strains from the food supply. But that has opened a path for other types of toxin-producing strains — of which there are hundreds.

It’s unclear how many of these non-O157 strains are involved in U.S. food-borne infections because they’re harder to test for. “But when we do studies looking for them, they make up well over half of all the hemorrhagic E. coli illnesses out there,” Osterholm tells Shots. “And we think that number is actually increasing, not decreasing.”

To read the full article, Link

New and deadly E-coli strain causes epidemic in 12 countries, spreading kidney failure, serious neurological symptoms, and death

June 4, 2011 at 2:53 pm By Roz Potter

Sources:

World Health Organization update #6   Link

Center for Infectious Disease Research and Policy from the Univ of Minnesota:   Link

June 2011 update from Eurosurveillance:   Link

From H5N1 blog:  a translation of an article from the German Ärzte Zeitung: EHEC: Early neurological therapy recommended, Link

Excerpts:

The count of cases (some severely ill with renal failure and serious neurological symptoms) and deaths in Europe’s Escherichia coli outbreak pushes higher daily, with official case counts of around 1700, with many others likely uncounted. The epidemic has been traced to Hamburg, Germany but the exact source remains unknown.  Many who are infected attended a 2 day Festival in Hamburg.

A WHO expert, Donato Greco, told the Italian newspaper La Repubblica: “The virus is found in intestines of cattle and therefore usually in raw meat such as tartar or poorly cooked hamburgers.” He said he had never yet seen such dangerous intestinal bacteria on fruits and vegetables.

There are two types of infection, one,with fewer victims involves hemolytic uremic syndrome (HUS), or potentially fatal kidney failure. A number of victims are on dialysis.

*****

The German Society of Neurology (DGN) has reported that about half of patients with hemolytic-uremic syndrome (HUS) may also suffer from severe and sometimes irreversible neurological disorders.

Two Hamburg neurologists, Professor Joachim Roether and Professor Christian Gerloff, say that is is alarming that the neurological condition in spite of early plasmapheresis does not improve or even deteriorates.

Gerloff is director of neurology at the University Hospital Hamburg-Eppendorf (UKE), Roether is Chief of Neurology at the Asklepios Clinic Altona.

Espeically striking is the early appearance of neurological symptoms, says Gerloff. “It can develop simultaneously with renal and gastroenterological symptoms.”

Crucial features of HUS are bloody diarrhea, hemolysis, and renal dysfunction.  In the neurological symptom complex in HUS, the first are confusion, reduced vigilance, irritability and delirium. There are also many cases of aphasia and apraxia, and disturbances of the brain stem functions. In severe cases, patients develop myoclonic seizures and sometimes that can lead to coma.

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